Understanding factors that influence uptake of ART services in India: A study of service data from antiretroviral treatment centers (ARTCs) across seven states
Poster presentation at the XVIII International AIDS Conference, Vienna, 20 July
Sarna,Avina; Bachani,Damodar; Sogarwal,Ruchi; Battala,Madhusudana; Saggurti,Niranjan; Sebastian,Mary Philip
Publication date: 2010
HIV testing is available in almost all districts of India, and free treatment at ARTCs across 174 districts. Despite this network of free services not all HIV-positive persons access ART services. The Population Council and NACO studied the characteristics of individuals accessing ARTCs and explored factors influencing uptake of ART services. We present findings from ARTCs across Rajasthan, Uttar Pradesh, Gujarat, Manipur, Andhra Pradesh, Maharashtra, and Karnataka.
We analyzed service data from registers and patient cards of newly registered HIV-positive persons at 10 ARTCs from 1 October 2008 to 31 March 2009.
11,568 HIV-positive patients (51% male) registered at 10 ARTCs over six months. Overall, 50 percent of patients were illiterate (female: 59%; male: 41%; p< 0.001), 22 percent had primary or secondary education, and 6 percent higher education; 71 percent were married (female: 58%; male: 83%; p< 0.001), 21 percent widowed (female: 35%; male: 7%; p< 0.001), 6 percent single, and 3 percent divorced; and 81 percent were unemployed (female: 92%; male: 71%; P< 0.001). Sixty-seven percent of patients were referred from ICTCs, 16 percent from NGOs, 4 percent from private practitioners, 6 percent from clinical services (TB/PMTCT/OPD/ward), 6 percent were self-referred, and 2 percent other. Sixty-one percent of the patients had first-visit CD4 counts < 250cells/ml. The majority registered at ARTCs within one month of being tested HIV-positive (63%), 11 percent by three months, 7 percent by six months, 6 percent by 12 months, and 12 percent after a year. On multivariate analysis, widowed (AOR:1.40 [1.20-1.62] p< 0.001), separated (AOR:1.65 [1.18-2.31] p=0.003), and patients with primary education (AOR:1.22 [1.06-1.40] p=0.004) were more likely to register after one month of HIV diagnosis, while patients older than 45 years (AOR:0.805 [0.65-0.98] p=0.04) and those with CD4 counts > 250 cells/ml (AOR:0.82 [0.73-0.92] p=0.002) were less likely to register after one month.
Vulnerable subgroups such as widowed, low-literacy, young, and sick patients may need support to access ART services. Staff at HIV testing centers should be trained to identify vulnerable patients and provide assistance to reach ARTCs.